BLEEDING/BLOOD LOSS

The amount of blood in our body varies in relation to our size. A rough rule of thumb is that we have
approximately one pint of blood per stone in body weight (0.5 litre, per 7kg), so the average adult has
between 8 and 12 pint' (4.5 to 6.5 litre,) of blood, dependent on their size (but the rule doesn't work for
someone who is overweight).

Types of bleeding
Arterial Blood in the arteries is under direct pressure from the heart pumping and spurts in time with
the heart beat. A wound to a major artery could result in blood 'spurting' several metres and the blood
volume will rapidly reduce.
Blood in the arteries is rich in oxygen and is said to be 'bright red', however this can be difficult to assess.
The most important factor is how the wound bleeds.
Venous Veins are not under direct pressure from the heart, but veins carry the same volume of blood as
the arteries. A wound to a major vein may 'ooze' profusely_
Capillary Bleeding from capillaries occurs in all wounds. Although the flow may appear fast at first, blood
loss is usually slight and is easily controlled. Bleeding from a capillary could be described as a 'trickle' of
blood.
As you can see, a loss of 300/0 of blood volume is critical - the patient's condition rapidly deteriorates
from this point onwards. Blood vessels cannot constrict any further and the heart cannot beat any
faster, so blood pressure falls, resulting in unconsciousness and then death.

Treatment of external bleeding

The aims of treatment for external bleeding are firstly to stop the bleeding, preventing the casualty from
going into shock, and then to prevent infection.

S.E.E.P. will help you to remember the steps of treatment:

S-it or lay
E-xamine
E-levate
P-ressure

Sit or lay the casualty down. Place them in a position that is appropriate to the location of the wound
and the extent of their bleeding.
Examine the wound. Look for foreign objects and note how the wound is bleeding. Remember what it
looks like, so you can describe it to medical staff when it's covered with a bandage.
Elevate the wound. Ensure that the wound is above the level of the heart, using gravity to reduce the
blood flow to the injury.
Apply direct or indirect pressure to stem bleeding:

Direct pressure
The best way to stem bleeding is by applying direct pressure over the wound. Immediate pressure can
be applied with the hand, however you should take precautions to prevent yourself from coming into
contact with the patient's blood, preferably by wearing disposable gloves. The pressure should be
continuous for 1 0 minutes. A firm bandage (not so tight as to stop circulation to the limb altogether!) is
usually sufficient to stop bleeding from most minor wounds. If there is an embedded object in the
wound, you may be able to apply pressure at either side of the object.

Indirect pressure
If direct pressure for a wound on a limb is not possible or effective, indirect pressure can be used as a
last resort. Pressure can be applied to the artery supplying the limb, squashing it against a bone and
reducing the blood flow. Apply indirect pressure for a maximum of 10 minutes.
The two main indirect pressure points are:
- Brachial
- Femoral

Dressings
Pressure is applied to the brachial artery, which runs on the inside of the upper arm. One way of doing
this is to get the patient to make a fist with their opposite hand, place it under their arm pit and squeeze
the injured arm down onto the fist.
Pressure is applied to the femoral artery, which is located where the thigh bone (femur) crosses the
'bikini line'. Take care to explain your actions.
One way of doing this is to use the heel of your foot to apply the pressure.